OBJECTIVE: Colorectal cancer (CRC) leads to significant morbidity/mortality worldwide. Defining critical research gaps (RG), their prioritisation and resolution, could improve patient outcomes.
DESIGN: RG analysis was conducted by a multidisciplinary panel of patients, clinicians and researchers (n=71). Eight working groups (WG) were constituted: discovery science; risk; prevention; early diagnosis and screening; pathology; curative treatment; stage IV disease; and living with and beyond CRC. A series of discussions led to development of draft papers by each WG, which were evaluated by a 20-strong patient panel. A final list of RGs and research recommendations (RR) was endorsed by all participants.
RESULTS: Fifteen critical RGs are summarised below: RG1: Lack of realistic models that recapitulate tumour/tumour micro/macroenvironment; RG2: Insufficient evidence on precise contributions of genetic/environmental/lifestyle factors to CRC risk; RG3: Pressing need for prevention trials; RG4: Lack of integration of different prevention approaches; RG5: Lack of optimal strategies for CRC screening; RG6: Lack of effective triage systems for invasive investigations; RG7: Imprecise pathological assessment of CRC; RG8: Lack of qualified personnel in genomics, data sciences and digital pathology; RG9: Inadequate assessment/communication of risk, benefit and uncertainty of treatment choices; RG10: Need for novel technologies/interventions to improve curative outcomes; RG11: Lack of approaches that recognise molecular interplay between metastasising tumours and their microenvironment; RG12: Lack of reliable biomarkers to guide stage IV treatment; RG13: Need to increase understanding of health related quality of life (HRQOL) and promote residual symptom resolution; RG14: Lack of coordination of CRC research/funding; RG15: Lack of effective communication between relevant stakeholders.
CONCLUSION: Prioritising research activity and funding could have a significant impact on reducing CRC disease burden over the next 5 years.
We would like to thank the contribution of all our Working Group members and those who took part in the BCUK-RG Evaluation Day (online supplementary appendix 2). Bowel Cancer UK staff member Sam Pearce was responsible for coordinating and delivering the logistics of the process, and Dr Julia Ambler was responsible for manuscript coordination. We thank Dr Alexis Willet who provided editorial assistance on behalf of Punch Consulting. We are grateful to Charles Russel Speechlys (5 Fleet Place, London) and Lewis PR (30 Millbank, London) for providing meeting spaces pro bono.
- Biomedical Research/methods
- Colorectal Neoplasms/diagnosis
- Early Detection of Cancer/methods
- Evidence-Based Medicine/methods
- Gene-Environment Interaction
- Genetic Predisposition to Disease
- Risk Factors